An Instapot. I’ve long been a fan of pressure cookers, but the Instapot takes it to the next level. This is my new favorite kitchen tool and it’s high on my list because it both saves time and increases healthy food consumption!

A subscription to Headspace. This might seem counter-intuitive since it adds a 10 minute task to their day… but there are data (and lots of testimony) that a daily mediation practice “expands time” by decreasing stress.

If they live close enough to walk or bike to school/work, think about something that might help them combine that commute with getting some exercise. How old is their bicycle? How about panniers to store gear on a bike? Would a great backpack help if they are likely to walk? How about a gift certificate to a bicycle shop?

Your time. Can you cook some meals once a month and put them in their freezer?. Do laundry? Bake cookies and mail them? Get their car washed? Make an elaborate certificate with something you could do for them and wrap it as a present.

On the flight home yesterday I finished Big Magic: Creative Living Beyond Fear by Elizabeth Gilbert (She’s probably known to you for her NY Times Best Seller Eat, Pray, Love). For me, one of the overarching messages of her book was this – When you see what you do as your vocation (from Latin vocātiō, meaning “a call or summons”), and not just your job, it will transform how you view your work – a concept which I believe may be necessary (but not sufficient) to treat or prevent burnout.

As I read her thoughts on how to live a creative life, I realized that there were other ideas that applied to physicians, physicians in training and others who serve:

Just show up. Every day.

“Most of my writing life consists of nothing more than unglamorous, disciplined labor. I sit at my desk and I work like a farmer, and that’s how it gets done. Most of it is not fairy dust in the least”

Learning and practicing medicine (or any other field) means showing up – really showing up – every day. Everyone in the first year of medical school learns that it is different than college. Cramming for exams is not only ineffective, it’s just wrong. You are no longer studying for a grade on a test…. it’s now about the patients you will take care of in the future. The same holds true during residency and when you begin your practice. It’s not just when you are a trainee. Part of the “work” of medicine remains “unglamorous, disciplined labor”… keeping up with the literature, going to teaching conferences when you could be doing something else, finishing your hospital charts, being on call.

But the work of medicine is also about showing up every day in another sense, too – truly showing up for the people who rely on you – no matter what. That, too, can be “unglamorous, disciplined labor” when you are tired or stressed.

“Work with all your heart, because—I promise—if you show up for your work day after day after day after day, you just might get lucky enough some random morning to burst right into bloom.”

“They are your patients… from the first day of medical school until you retire.

“Most of all, there is this truth: No matter how great your teachers may be, and no matter how esteemed your academy’s reputation, eventually you will have to do the work by yourself. Eventually, the teachers won’t be there anymore. The walls of the school will fall away, and you’ll be on your own. The hours that you will then put into practice, study, auditions, and creation will be entirely up to you. The sooner and more passionately you get married to this idea—that it is ultimately entirely up to you—the better off you’ll be.”

Caring for others gives us joy but also gives us the responsibility to know the best thing to do for them. Whether you are a first year student, 3rd year resident or a PGY35 attending, we are all still learning. “Life long learning” is not just a phrase, it’s the reality of what we do.

“It’s a simple and generous rule of life that whatever you practice, you will improve at.”

Learn the art of deliberate practice early. Deliberate practice, to use a musical analogy I learned in Cal Newton’s fantastic book So Good They Can’t Ignore You: Why Skills Trump Passion in the Quest for Work You Love, doesn’t mean playing the piece from start to finish 20 times in an hour. It means spending 55 minutes on the small section that you struggle with, repeating it 100 times before you play the piece through once. It means instead of reading the comfortable material on the anatomy of the kidney, you deliberately tackle how the nephron works. It means that instead of doing the computer-simulated cholecystectomy 10 times you spend an hour tying intracorporeal knots in the trainer. Find the thing that is not easy and practice it over and over until it becomes easy.

“There are only so many hours in a day, after all. There are only so many days in a year, only so many years in a life. You do what you can do, as competently as possible within a reasonable time frame, and then you let it go.”

One of the greatest attributes of those who care for others is their devotion to the people they serve. But perfectionism, taken to its extreme, is dangerous. Extending your time to study for Step 1 beyond what is reasonable to try to get a higher score, revisiting decisions about patient care to the point of anxiety, worrying that your GPA has to be perfect are all counterproductive. The motivation to do well is like a cardiac sarcomere – a little worry will make you more effective, but stretched too far, there won’t be any output at all.

“No, when I refer to “creative living,” I am speaking more broadly. I’m talking about living a life that is driven more strongly by curiosity than by fear.”

It’s something most students don’t realize, but no matter how long you practice medicine, there are days when you are afraid. It takes courage to do what we do. Remember, being courageous is not an absence of fear, it’s being able to do what’s right despite the fear. I agree complete with Elizabeth Gilbert that curiosity helps. When you have something that doesn’t go the way you expect or frightens you, instead of beating yourself up (“I should have studied more”….”I could have made a different decision”…etc…etc) become curious. If you are thinking about a complication, commit to finding everything you can about the procedure and how to prevent complications. If you didn’t do as well on your test as you thought you should, look up different techniques to study, take notes, and remember information, and go back to make sure you really understood what was being tested.

Even more powerful than curiosity is gratitude. Fear and gratitude cannot exist at the same moment. Try it – the next time you are about to snap because your EMR freezes be grateful that you can see the computer, be grateful you have work, be grateful you have been trained to help other human beings …and see what happens.

“We must have the stubbornness to accept our gladness in the ruthless furnace of this world.”

“You can measure your worth by your dedication to your path, not by your successes or failures.”

Wow…. This one is so important.

It’s not what you make on Step 1. It’s not how many cases you do, how many patients you see or how much money you make. This concept is taught by every religion and philosopher I know – for a reason. Be devoted to doing the best you can and to forgiving yourself (and learning from it) when you fall short.

Find something, even a little tiny thing, that makes you curious (or fills you with wonder) and follow it. Dedicate yourself to following that curiosity and it will likely lead you to your career.

“May I also urge you to forget about passion? Perhaps you are surprised to hear this from me, but I am somewhat against passion. Or at least, I am against the preaching of passion. I don’t believe in telling people, “All you need to do is to follow your passion, and everything will be fine.” I think this can be an unhelpful and even cruel suggestion at times. First of all, it can be an unnecessary piece of advice, because if someone has a clear passion, odds are they’re already following it and they don’t need anyone to tell them to pursue it…..I believe that curiosity is the secret. Curiosity is the truth and the way of creative living. Curiosity is the alpha and the omega, the beginning and the end. Furthermore, curiosity is accessible to everyone…..In fact, curiosity only ever asks one simple question: “Is there anything you’re interested in?” Anything? Even a tiny bit? No matter how mundane or small?….But in that moment, if you can pause and identify even one tiny speck of interest in something, then curiosity will ask you to turn your head a quarter of an inch and look at the thing a wee bit closer. Do it. It’s a clue. It might seem like nothing, but it’s a clue. Follow that clue. Trust it. See where curiosity will lead you next. Then follow the next clue, and the next, and the next. Remember, it doesn’t have to be a voice in the desert; it’s just a harmless little scavenger hunt. Following that scavenger hunt of curiosity can lead you to amazing, unexpected places. It may even eventually lead you to your passion—albeit through a strange, untraceable passageway of back alleys, underground caves, and secret doors.

At the most recent ACS Clinical Congress, I was really struck by a presentation on mindfulness given by Sharmila Dissanaike and asked her if she would be willing to write about the topic for wellnessrounds. To my delight she agreed!

The recent #Ilooklikeasurgeon phenomenon reminded me that times do indeed change – albeit slowly. The peak of this phenomenon happened to coincide with my talk at the American College of Surgeons on “Mindfulness for Stress Reduction and Burnout Prevention”. If you had told me 10 years ago that I would one day deliver this brief lesson in stepping off the treadmill for a few moments, I would have said you were crazy. Surgery was only for the tough, and the tough don’t need breaks (or so we thought). As a woman surgeon, it was even more important to me that no chinks show in the armor, and being a trauma surgeon proved an easy way to solidify my “street cred” despite being a 5”2’ little brown woman with long hair.

So it has taken a while for me to feel confident enough to broach such a “soft” topic in a public surgical forum. Obviously age and (a little) wisdom has probably helped, but there is also a tangible change in the prevailing culture of surgery as exemplified by the #Ilooklikeasurgeon movement and other similar initiatives; where calling for help is no longer an (automatic) sign of weakness, and the surgical community has accepted that the good old days (or bad old days, depending on your perspective) are well and truly over. The next generation of surgeons is currently being greeted with much hand wringing and wailing and gnashing of teeth, for how could a group of kids raised in this limited workhour era possibly achieve the heights of excellence that the “old school” surgical residents achieved? Since the switch to 80-hour workweek happened exactly midway through my residency, I have the privilege of a foot in both worlds, and while I agree that our training paradigms do have to change, I am not yet ready to concede that the golden age of surgery is well and truly behind us. Partly, this is because of the audience that gathered for the session at ACS. What stunned me even more than the opportunity to speak on mindfulness was the full house that gathered for this session, and the enthusiasm and interest generated by a wonderful audience of men and women of all ages, and in nearly equal proportions – it embarrasses me to admit that I had expected to be speaking to a handful of younger female surgeons. Instead, I met the 65 year old broad-based general surgeon who came because he recently lost a younger orthopedic surgeon colleague to suicide – by stabbing himself through both femoral arteries, with surgical precision of course. I met several Governors of the College, who were in the classic “grey haired” demographic, and yet optimistic and enthusiastic about the future of surgery, and the improvements to be had by focusing more on our wellness – that “healing the healer” would have tangible results not just for our own wellbeing but also that of our families and our patients, and was thus an obligation, not an option. I met young surgeons a few years out of residency/fellowship who had already recognized the need for maintaining their own mental health in order to remain functional for as long as possible in order to maximize the productivity to be gained from their long training – working less was certainly not on their priority list. There was clear recognition of the systemic problems that drive a lot of surgeon frustration with ensuing burnout – bureaucracy, being treated as interchangeable expendable cogs in a machine, electronic medical records and endless paperwork topping the list – and yet there was also an acknowledgement that adjusting internal cognitive factors was at least as important for wellbeing as it was to try and change some of the external factors.

The methods I teach are focused on building resilience and capacity – characteristics that are both innate and learned, which can be developed and expanded through meditation and other techniques. One of my favorite analogies is that a spoon of salt in a cup of coffee renders it immediately unpalatable; the same spoon in a river or swimming pool would not be noticed. The spoon of salt represents the unavoidable daily irritants in our lives – the cases that run late, the scrub tech who doesn’t know what instruments you use, the colleague who lets you down in a key meeting. The cup of coffee of course is us – or at least, where most of us start. Instead of spending our lives either trying to avoid all these frustrations (which is futile) or becoming upset when they happen, mindfulness can increase our capacity to be with them fully, accept them for what they are and yet respond thoughtfully and effectively instead of blindly and automatically reacting with anger or frustration (which usually only causes us more trouble in the long run). Over time, we develop an increased capacity to handle irritation without it placing us in a perpetual bad mood, and increased resilience to bounce back from the inevitable traumas of life, both personal and professional.

So why teach mindfulness to surgeons, when there are plenty of other things I could be doing that would probably be more directly beneficial to my career? Because I do believe that the biggest waste of potential is to take a motivated young person, put them through the grueling training to be a surgeon, set them out on a career that is of such benefit to society, and then allow them to flounder and become discouraged 5 – 10 years later, quickly discarding those hard-earned skills as they turn into full time administrators, wound care docs or some other alternate career path. Not that there isn’t value to these professions of course, and some people do realize at a late stage that they are better suited to another path – in which case all of these are excellent choices. But too often it is one bad outcome that leads to a malpractice suit, or some other event that proves just too difficult to handle, that completely derails an otherwise excellent surgeon and this lack of coping – the lack of capacity, and resilience – leads to a complete abandonment of what should be an intrinsically rewarding career.

If mindfulness, meditation and other strategies can help even one surgeon regain a wider perspective and avoid this outcome, then it will have been a worthwhile endeavor.

Dr. Dissanaike is a general surgeon with primary focus in trauma, burns and critical care, and a Professor at the Texas Tech University Health Sciences Center in Lubbock, TX. She serves as Medical Director of the Level 1 Trauma Center and Co-Director of the regional Burn Center. She has an interest in ethics and humanism, and is on the ethics committees of both the American College of Surgeons (ACS) as well as the American Burn Association.

My heart breaks for Sheryl Sandberg’s loss of her husband … and I am so grateful for her honesty, her wisdom and for the effort it took to share her journey. As I read her post on Facebook today, I realized that all of us in medicine could benefit from her thoughts as she ends sheloshim, the Jewish 30 days of mourning for the loss of a spouse.

One of the things that is so hard to teach in medical school (and all other health professions) is to honor the resilience of those we accompany on their journey through times of struggle and loss. It is so hard to let go and realize there is nothing to “fix” in these situations. Far more important than trying to convince our patients, their families or our friends that it will be “better” or that there is “hope”… we need to commit to just being there with them, and walking with them on this very human… but incredibly hard journey.

“I have learned that I never really knew what to say to others in need. I think I got this all wrong before; I tried to assure people that it would be okay, thinking that hope was the most comforting thing I could offer. A friend of mine with late-stage cancer told me that the worst thing people could say to him was “It is going to be okay.” That voice in his head would scream, How do you know it is going to be okay? Do you not understand that I might die? I learned this past month what he was trying to teach me. Real empathy is sometimes not insisting that it will be okay but acknowledging that it is not. When people say to me, “You and your children will find happiness again,” my heart tells me, Yes, I believe that, but I know I will never feel pure joy again. Those who have said, “You will find a new normal, but it will never be as good” comfort me more because they know and speak the truth.”

This is an amazing cookbook and it is perfect for busy people. The recipes are interesting, delicious and healthy. The instructions are easy for a novice without being simplistic and the layout of the book in innovative and makes it really easy to use.

Slow cookers are often suggested for medical students and residents but I don’t think they are as good as a pressure cooker. You have to be there when slow cookers are (slowly) cooking, which is usually your rare day off. Also, it’s hard to cook vegetables in a slow cooker. Pressure cookers on the other hand cook broccoli in 2 minutes (perfectly!). I’ve been told that the electric pressure cookers take a little longer to come up to pressure, but it seems a small downside for a device that also lets you slow cook, steam, sauté, and cook rice.

Anyone in medicine loves gadgets and loves data. The fitbit has become a socially acceptable piece of “jewelry” in the hospital and it unquestionably changes behavior to increase activity. Having washed three of the “clip on” Fitbits with my scrubs, I would recommend one of the wristband Fitbits!

Doing housework has to be on everyone’s lowest list of fun things to do on your day off, but it’s especially true for people who are studying extensively or taking call in the hospital. My parents helped finance someone to come occasionally to help clean my apartment when I was an intern. It was without a doubt the best present I’ve ever received.

Another great gift is anything that will promote more exercise… a bicycle to commute to school or work? Yoga classes? Spin classes? A gift certificate for new running shoes? Resistance bands for the call room? A membership to a YMCA or a gym close to where they live? Certificates for post workout massages?

Whether they are single or have a significant other, being able to socialize is an important part of stress reduction for busy people. Create combinations of gift cards to movie theaters and restaurants to support “date nights”. If they love art, music, or sports think of season tickets (or ticket packages) to museums, music venues or professional sport teams.

It’s not easy getting up at “dark thirty” to make it to rounds, but being on time is important. The snooze button is not a good idea… but it’s so easy to hit. This alarm clock is my personal favorite to make sure you get out of bed. After a few hits of the snooze button, it rolls off the table and around the room until you turn it off!

If they are a serious reader, think about a Kindle (or other eReader). The Kindle paperwhite is small, lightweight, back lit and has a great battery life – which makes it great for the occasional times on call that you can find 30 minutes to escape into a good book. You can also read it outside in bright sunlight (unlike tablets like the iPad) On my list of great reads for doctors (in no particular order)…

Running is one of the most efficient ways for busy students, resident and physicians to stay in shape. If you are looking for the best way to meet your “MED” (Minimal Exercise Dose) to stay fit, you really can’t do better than running. It’s cheap (but don’t skimp too much on the shoes and clothes you need), easy (we are born to do it) and incredibly time efficient. You don’t have to plan to run a marathon to gain amazing benefits from a running program. 20-30 minutes, 3-4 times a week, will keep you fit, reduce stress, and prevent the weight gain associated with residency. If you are a beginner, check out Runner’s World 8 week to start running.

I work with a remarkable runner, Carlos Campos MD, who wrote the following for the Texas Children’s Hospital Department of Surgery wellness newsletter. Given how hot it is in most of the country right now, I thought the following advice was important to pass on!

Training in hot weather can be challenging, and without the proper precautions it can be dangerous. But a few easy guidelines can help you beat the heat.

Before stepping out on a hot day, make sure to check the heat index. The heat index combines air temperature and relative humidity to determine how hot it feels. The National Weather Service offers heat index alerts when it becomes dangerous to exercise outdoors.

Your body cools itself with perspiration which evaporates and carries heat away. When the relative humidity is high, the evaporation rate is reduced and heat is removed from the body at a slower rate.

One way to get through those hot and humid days is to avoid them. When the heat index reaches dangerous levels consider taking that well deserved day off.

If avoidance is not an option for you, try running in the early morning or early evening when the heat index is typically lower.

Another option is to do your workout indoors. A climate-controlled indoor track or treadmill can serve as an alternative to running under the scorching sun. However, not everyone has the luxury of an indoor facility so you need to plan accordingly.

You’ve probably heard the saying “there’s no bad weather just bad clothing.” Whether or not it’s true, you should always wear temperature-appropriate gear, especially when running in the heat.

Avoid dark colors since they tend to absorb heat rather then reflect it. Find clothing that is made of high performance technical materials. These materials wick or pull moisture away from your body while allowing air to flow through the material. Wicking materials are a great improvement over cotton, which tends to absorb moisture and can contribute to chaffing.

Find a Cool Course

Temperatures tend to be a few degrees cooler in the shade, so look for a running route that offers lots of it. It’s also a great excuse to get off-road and do a little cross-country training.

If you are lucky enough to live near the coast, you may want to consider a beach run. Temperatures are cooler along coastal areas, and you can always go for a quick dip to cool down.

Consider looking for an athletic facility that waters their fields with sprinklers. Running through sprinklers serves a dual purpose: It helps keep you cool and makes you feel like you’re 12 again.

Protect Your Skin From the Sun

Wearing sun block is a must. The occurrence of skin cancer is on the rise and without protection, you increase your risk. The higher the sun protection factor or SPF, the more effective the sun block is in protecting your skin against harmful rays. For example, sun block rated at SPF 30 filters out about 96 percent of ultra violet rays.

The sun’s rays are strongest between 10:00 a.m. and 4:00 p.m., so avoid training during these hours. It is recommended that sun block be applied about 30 minutes before going outdoors and every hour after.

The first women’s marathon was introduced at the 1984 Summer Olympics in Los Angeles. As you can imagine, summers in LA are hot, and the morning of the marathon was no exception. To make matters worse, most of the course was on freeways that offered no escape from the sun.

To compensate for the conditions, Joan Benoit Samuelson wore a white cap with a wide brim. The cap served the dual purpose of shielding her from the harmful rays of the sun and acting as a cooling device. Periodically she would pour water on the cap. She finished a minute ahead of her rivals to win the first women’s Olympic gold medal in the marathon.

Today’s running caps are made of high-tech materials that are both light and vented. Just add a little water to help keep cool.

If you don’t like wearing hats or want additional protection for your eyes, wear sunglasses. Make sure you find sunglasses that come with UV coating.

The following is written by a colleague who is now in practice and has been for several years. It is a heartfelt account of discovery, action and recovery… one that I thought was well worth sharing.

During the third year of my general surgery residency I navigated to a website and read the following:

Answer YES or NO to the following questions.

1 – Have you ever decided to stop drinking for a week or so, but only lasted for a couple of days?
2 – Do you wish people would mind their own business about your drinking– stop telling you what to do?
3 – Have you ever switched from one kind of drink to another in the hope that this would keep you from getting drunk?

4 – Have you had to have an eye-opener upon awakening during the past year?

5 – Do you envy people who can drink without getting into trouble?

6 – Have you had problems connected with drinking during the past year?

7 – Has your drinking caused trouble at home?

8 – Do you ever try to get “extra” drinks at a party because you do not get enough?

9 – Do you tell yourself you can stop drinking any time you want to, even though you keep getting drunk when you don’t mean to?

10 – Have you missed days of work or school because of drinking?

11 – Do you have “blackouts”?

12 – Have you ever felt that your life would be better if you did not drink?

The website was Alcoholics Anonymous, www.aa.org. The website defines a score of four or higher as representative of someone who likely has a problem with alcohol. I answered “yes” to all twelve.

Although upsetting at the time, this information did little to create lasting change in my life. I was still in a profoundly stressful work environment, buried deep in a culture where using alcohol to displace anxiety, anger, frustration, and chronic fatigue, was commonplace.

Why alcohol? I never drank in high school. I never drank in college. I never drank in medical school. I was 28 year of age when I took my first drink, three months into my intern year. I had avoided alcohol for many years because of a family history marred with alcoholism. Why now? The backdrop is a spiritual valley that I had slowly descended into over several years. My former childlike faith seemed like that alone, childlike. There were too many unanswered questions, too many competing world-views. I disengaged from the conversation. I was able to limp through medical school in this state but residency would soon take me to rock bottom. This was a painful world of crushing fatigue, heart-wrenching grief, and endless performance pressure. The anxiety was unbearable. I became infatuated with alcohol because it worked. I felt less anxious. I was able to relax. I was able to commiserate with fellow residents, laugh, complain, and forget…..at least, temporarily. I justified my behavior by telling myself it was a short-term coping mechanism. I only needed to drink to survive residency, it would be a fleeting crutch. Then I started giving a more honest account of my habits: when I was excited and wanted to celebrate – I drank, when I was angry and frustrated – I drank, when I was dejected and depressed – I drank, and when I was bored – I drank. There was no occasion where alcohol wasn’t indicated. It became more than a crutch. Just walking through the basics of life were reason enough to have a drink, not to treat anxiety, but to prevent it.

Admitting you have a problem is always the first step but still miles away from sobriety. I was on vacation abroad when I saw a figurative fork in the road. I knew that if I continued to drink I would either lose my job, permanently damage relationships, or risk my life. I had already managed to avoid paying full price for my behavior to that point and it was clear to me there would be no more opportunities to move on without deep wounds. How could I risk all that I had worked so hard to achieve and all the wonderful GIFTS in my life? The gifts of family, health, and a fortuitous background that enabled success. I went back to the basics. My family, my faith – the very things that had served me so well, for so long. I found peace. I found self-confidence. I realized that showing emotion over the loss of a stranger’s son in the trauma bay was a caring thing to do, not something to fight and hold back. I realized that late-night drinking only made my fatigue worse, adding to my stress level. I realized that a poor speaking performance in front of an attending would soon be forgiven and forgotten, and made up for another time. When anxiety would overwhelm me, I would pray. And that worked too, with the benefit of no hangover.

If you or someone you know is struggling with substance abuse, don’t wait for a tragedy to act.

Find someone you trust and confide in them. Talk to someone in your house of worship, or sit down with your favorite uncle, your high school chemistry teacher. Go to a meeting of Alcoholics Anonymous, or tap into numerous other resources.

This is a problem that medical schools and residency programs are familiar with. If you are a medical student, talk to your Dean of Student Affairs. If you are a resident, talk to your Program Director. If you are too worried to do that, at least find someone who is familiar with addiction in your community and talk to them.

It’s normal that you might be worried about asking for help, but realize that asking for help will not lead to problems with your medical license … but being arrested for a DUI will.

If you’d like to reach me, you can contact me through Dr. Brandt by clicking on the “Contact” button on the bar at the top of this page. Needless to say, it will be completely confidential.

New findings about sedentary behavior have real implications for medical students, who spend a lot of time sitting during the first year or two of medical school. This is also an important issue for residents and practicing physicians, particularly those in the more sedentary fields of medicine like pathology, psychiatry and radiology. However, this problem affects us all, regardless of specialty. All physicians have become more sedentary due to the time we spend at our computers.

Stand when you can. Stand when you are reading, working on the computer (with an adjustable desk), or just hanging out.

Walk instead of looking up data on the computer on rounds. I’ve recently discovered I can access our EMR (Epic) on my iPad by installing the Citrix app. I’ve started taking my iPad with me on rounds, rather than sitting to look up notes, images and lab values. I’m still not to the point where I write my notes on the iPad, but I’m going to work on it.

Twitter has become a wonderful way for me to send out a variety of ideas and links that I think are helpful (and/or interesting). Here are this week’s highlights! If you are new to Twitter RT means Retweet (just “forwarding” it as is) and MT means Modified Tweet (“forwarding” it with a comment).